Off your head?

As a series of new studies proves the link between cannabis dependency and mental illness, an Observer investigation reveals the plight of young users struggling to find help to deal with the disturbing effects of a drug once considered 'safe'.

Daniel Hrekow is 23, articulate, musically talented and academically bright. In the past five years he has dropped out of two universities and experienced two breakdowns. At the age of 19, after several years of feeling depressed, anxious and increasingly disconnected, he was diagnosed as having Asperger's syndrome, a form of autism.

Signs of Asperger's include an inability to empathise or understand other people's emotions, difficulty in tolerating change and obsessional behaviour. In Daniel's case, this obsessional behaviour can mean periods of smoking cannabis for several days and nights at a time. Since his teens, out of fear and frustration, Daniel has tried to control every aspect of his mother Mary's life. He has also become extremely violent to her, his father, Peter, and younger brother, Ben.

Daniel is the human face of a disturbing statistic revealed last week - an alarming 40 per cent rise in hospital admissions for mental ill-health prompted by cannabis use since 2001, when it was first proposed to downgrade it from a Class B to Class C drug.

A new study demonstrating the link between psychosis and cannabis - written by Professor Tom Barnes - will be published in the Journal of Psychiatry next month, adding yet more pressure on the government to take a fresh look at the price paid by increasing numbers of young people dependent on cannabis.

Daniel is just one example of this growing problem. 'When he's violent, he bangs his head against the wall, punches and shakes me, smashes furniture and cuts himself with kitchen knives,' says Mary. His parents have had to ask the police to remove their son from the family home several times - and again this weekend, Daniel has been abusive and threatening. Meanwhile, he and his mother are waiting to hear if a place will be funded for him at the Rookery, in Somerset, one of the few residential settings in the UK offering education for young people with Asperger's.

Mary has fought hard to acquire support for Daniel from the South West London and St George's Mental Health NHS Trust, often with little success. At one point the Hrekows, both education consultants, remortgaged their home to raise more than £30,000 to pay for Daniel's care.

Last September, after 18 months in a residential unit, Daniel decided to return to university. He was supposed to receive support but none was forthcoming from the trust. After several weeks at Goldsmiths College in London, he began to do what he has always done, since the age of 15, to ease the pain of alienation - he began to smoke cannabis excessively.

'When you're trying to live life as a normal person, and you're stoned, you disguise yourself because you're pretty much out of it,' Daniel says.

He gives a long and moving account of life with a cannabis addiction. 'At first, with cannabis, it becomes so much easier to float by unnoticed. But then you become paranoid. You're quick to assume the world isn't going to make a place for you. Through drugs, I've come close to destroying myself, but sometimes the only option is to be in this oblivious state, trying to get a break from the pressure. But it's no break at all really.

'In my teens I used to champion cannabis but once you've taken yourself to places I've taken myself to, you can't hide from what your brain felt. Now, I don't get a high at all. Instead, my brain hurts so much, and I don't sleep for days. It goes wrong so quickly that what's going on internally becomes visible to everyone and that's frightening for me. No one at 23 who's been into cannabis for years can get away with saying it doesn't mess your head up. If you're smart and have potential and you do drugs for too long, it takes you further away from a healthy balanced way of living which is what you secretly wanted in the first place - with that first joint.'

In 2001, 490 patients were admitted to hospital as a result of excessive use of cannabis. There were 710 admissions in each of the past two years. Several recent studies have demonstrated the links between cannabis and schizophrenia. Professor Robin Murray, a consultant psychiatrist at the Maudsley Hospital in south London and one of the leading researchers in the field, estimates that 25,000 of the 250,000 people with schizophrenia in the UK could have avoided the illness if they had not used of cannabis.

In addition, the Advisory Council on the Misuse of Drugs (ACMD), in a report to Home Secretary Charles Clarke arguing against reclassification, suggested for the first time that cannabis may not only cause schizophrenia in those with pre-existing mental conditions, but could also exacerbate a range of other mental health problems.

In the UK, 250,000 people experience psychosis - a term that refers to symptoms including delusions and hallucinations, rather than a specific diagnosis. 'Five years ago, 95 per cent of psychiatrists would have said cannabis doesn't cause psychosis,' says Murray. 'Now, I would estimate 95 per cent say it does. It's a quiet epidemic.'

Steve Hammond, the 27-year-old son of mental health worker, Terry, began smoking cannabis at 16, graduated to smoking up to 10 joints a night over weekends, then, in his twenties, was diagnosed as schizophrenic.

'Steve was a brilliant sportsman: a gifted footballer, a superb runner, a natural athlete,' says his father. 'Now, he is just a shadow, a recluse. This is definitely an emerging issue. Everyone knows a "dope head" who has used cannabis, the "safe" drug. It's not just the number of cases of schizophrenia and psychosis that's a concern, it's the thousands upon thousands who have lost a future.'

The ACMD report says that 'the mental-health effects of cannabis are real and significant'. While it is true to say that many millions of people have used cannabis moderately without impairment to their daily lives, can we afford to ignore the hike in hospital admissions?

And have a number of recent court cases dealing with horrifically violent crimes involving cannabis raised us from years of torpor about the use of cannabis? Earlier this month, Peter Thomas, aged 21, was given an indefinite jail sentence after beating Lisa Voice, the mother of his former girlfriend, so severely that she needed 11 operations. 'He smashed my skull, my nose was a pulp... he smashed my eye sockets and my eye was hanging out,' Voice said. Medical experts said Thomas had been suffering from 'cannabis-induced psychosis'.

Charles Clarke promised last month to 'implement energetically' the three main recommendations of ACMD - a 'substantial' education campaign, strengthened medical services for those dependent on cannabis and further research into the implications of cannabis use - although whether there will be sufficient funding is extremely doubtful. In 2005, France spent £2 million to educate young people about cannabis. In comparison, a recent British public health campaign on the same issue received £230,000.

Next month, the National Treatment Agency for Substance Misuse is launching its Young People's Effectiveness Strategy for under 18s. Professionals say it is impossible for the strategy to encompass excessive cannabis use because so little is known about it - who is using it, how often, why some individuals appear more vulnerable than others to its effects and how many are seriously impaired. Nor do we know enough about what works in terms of 'education'. What is certain is that, in many parts of Britain, a young person with cannabis problem would be very fortunate indeed to find effective help. Heroin, cocaine and crack cocaine have a more established link to crime and death, so receive a far higher priority in public policy. Cannabis may lay waste to lives, but often the casualties suffer a lifetime of delusion and reclusiveness while their families privately mourn their loss.

For years, the debate on cannabis has progressed little. 'The issue has been polarised between those who argue that if everyone smokes it, it will lead to world peace and those who believe that a few spliffs may send you psychotic,' says Dr Luke Mitcheson, a clinical psychologist. 'That shows a deep immaturity in the face of increasing evidence that we need a far more sensitive dialogue.'

Cannabis is the most widely used illicit substance around the world, particularly among young adults. Users are smoking it from a younger age and in larger quantities for longer, not least because young people today have more ready cash than their Sixties counterparts did and a small quantity of cannabis is now cheaper than a packet of cigarettes or a couple of pints.

There has been a staggering 70 per cent increase in teenage mental-health problems since 1974, according to the Institute of Psychiatry. Young people in the UK use more cannabis than their peers on the continent. In the UK, latest statistics reveal that 1 per cent of all 11-year-olds, 17 per cent of 14-year-olds and 26 per cent of 15-year-olds used cannabis last year.

Cannabis, or marijuana, comes in different forms. Hash, the resin of the plant, is less expensive than grass or weed, which is the plant's dried leaves. 'Skunk', at around £200 an ounce, is herbal cannabis grown from selected seeds by intensive indoor methods. Skunk is twice as potent, on average, than hash or weed.

Some say the increase in psychosis and schizophrenia is because skunk is more readily available and easier to obtain than hash or grass, but other professionals believe that the market is simply responding to demand for the more 'mind-blowing' version. The ACMD said that the evidence on whether 'skunk' was playing a major part in the apparent increase in psychosis was 'unclear' because, there was 'too little information about the potency and pattern of use of cannabis by consumers'.

Cannabis, often mixed with tobacco, is either smoked in a joint or in a water pipe, or cooked into food and eaten. The plant contains more than 400 chemicals including delta-nine-tetrahydrocannabinol (THC), its main psychoactive component. Interactions between THC and specific proteins on the surface of the brain cells, known as cannabinoid receptors, produce the laid-back, pleasure-enhancing awareness after smoking cannabis and is sometimes accompanied by an urge to eat.

Recent breakthroughs in neuroscience show, contrary to earlier research, that even in adolescence the brain is still developing. A paper to be published soon as part of a campaign by the charity YoungMinds, explains how the frontal cortex - where this development takes place - is essential for functions such as response inhibition, emotional regulation, analysing problems and planning.

Research also shows that sustained use of cannabis over several years may result in cognitive impairment, affecting memory, attention and the organisation and integration of complex information.

Several controversial key studies have recently shown the impact of juvenile cannabis use. One, carried out by Murray and the University of Otago in New Zealand, followed a group of 750 adolescents over 15 years and found that those who had smoked cannabis at age 15 were four and half times more likely to be schizophrenic at age 26.

Two weeks ago in Portsmouth at the inquest of 23-year-old Roy Jackson, who died after bingeing on methadone and cough medicine, coroner David Horsley underlined the tragic downhill spiral that cannabis dependency can produce in a mentally ill person. Roy had begun to smoke joints at age 14 and eventually moved on to skunk. He was diagnosed as schizophrenic at 19. 'The use of cannabis exacerbated his mental health problems,' Horsley said. 'It predisposed him to smoking more regularly than was good for him.'

Roy's sister, Lisa Male, said: 'It was horrible. He was sectioned at 19 when it should have been the best time of his life. He had been a bright boy at school. One doctor told my mother that the increasing use of skunk had created a ticking time bomb.'

Roy's family, understandably, want the laws on cannabis tightened. But reclassification will not stop young people rolling a joint - nor will it encourage them to put a brake on excessive use.

Three months ago, J-Rock, an actor and a member of R&B group Big Brovaz, decided to give up 'the weed'. Now 27, he had smoked up to 10 spliffs a day from the age of 13. 'Everything in my life had weed around it,' he says. 'I was paranoid, I couldn't handle my life any more, I had to stop.'

But he was helped by an early-intervention counsellor, using motivational techniques which have proved successful in Australia and the USA. Contrary to myth, coming off cannabis can cause withdrawal symptoms - including insomnia, irritability and physical discomfort.

'I suddenly got my dreams back and they were really vivid. That was strange, but my counsellor had prepared me for that.'

J-Rock and the counsellor worked together three times a week. He was instructed to keep a diary, to look at when he smoked and why; he was encouraged to develop activities to distract himself from smoking and to establish goals for the future. Thirty-one days after giving up, a test showed THC was still inside his body. Yet now, he is drug-free.

'So many young people grow up seeing Snoop Doggy Dog smoking weed and they think you have to do that to achieve, to be creative through weed,' he says 'I'm successful beyond some people's dreams but I was doing it under the influence of drugs. Now, I'm acting, recording and it's a whole lot easier. This is me.'

'Given the right help, people can change surprisingly quickly,' says Mitcheson, who works clinical psychologist in Lambeth, south London. 'Just setting up a service for cannabis users isn't going to work. Young people don't identify with "I have a problem and yes the problem is cannabis". Often that's only part of a range of difficulties and adolescence is a time of change anyway when some become unstuck.'

The government has established 109 Early Intervention projects around the country. The concept is good but, in practice, some projects consist of a single worker covering many hundreds of miles. 'What we still have too often, is a service open five hours on a Monday, Wednesday and Friday,' says Kathryn Pugh of YoungMinds. 'What a young person needs is help on a Sunday night when he's alone in his bedsitter.'

Another problem is that a young person has to reach a crisis and experience a psychotic episode before help is given. Little exists for the heavy smoker who wants to cut back before it gets out of hand. Early Intervention projects may also suffer because of the financial crisis faced across the NHS. Government money allocated for young people's mental health budgets, however generous, is often siphoned off for other uses.

In-volve, a charity set up by Colin Cripps, runs 15 services for young people around the country. 'We've never tailored intervention in any way that made sense,' says Cripps. 'Now, following Danish research, we wait for a couple of weeks until a young person has got enough cannabis out of his or her system, then we work with them as a person not as a drug user. Most of the problems are about identity. Heavy users have often grown up feeling failures.

It takes weeks and weeks of intensive counselling of the right kind and opportunities for education, training and employment to persuade a young person they can make something of their lives. Only then is cannabis recognised as the problem.

'In-volve uses texting, flyers, chat rooms events and word of mouth to spread its message. So much of drugs education in this country ignores the changes in communication and leaves young people cold.'

The work of Dr Jim McCambridge, of the National Addiction Centre, and his colleagues, is beginning to demonstrate how young people are capable of helping themselves given the right opportunity. For the centre's ongoing study, students in colleges across London were randomly picked. Of those, 50 per cent subsequently said they had difficulties with cannabis. They were then interviewed for half an hour and, using motivational techniques, encouraged to evaluate their own lives and goals.

A few months later, the students were reassessed and it was discovered that the interview had had a positive impact on their behaviour. Studies are now taking place to test whether training in motivational techniques, for professionals such as teachers who come into contact with young people every day, might have a long-term impact on reducing drug use.

'Given the prevalence of cannabis, there's so much we don't know,' McCambridge said. 'Who's using heavily? Why? How best can they be helped? The tragedy is that with no overarching strategic direction, we have pockets of good practice and and waste lands where there is no help at all.'

James, in his twenties, began smoking cannabis at 15. 'The reason I never did any other drugs was because their dangers were well known. I was a sensible person,' he said, aware of the irony. 'Even when I went to two GPs, saying I was having problems with anxiety and paranoia, they gave me antidepressants and said if the cannabis helped me to relax, I should carry on.'

At 19, he had a breakdown and was hospitalised with drug-induced psychosis. At school, he achieved seven A stars in his GCSEs. Now he is unable to hold down a job. 'My brain works but I don't do well in social situations. If only I'd known about the risk.'

What's required now, experts in the field say, is for Charles Clarke to put his money where his mouth is. However large or small the issue of cannabis dependency, it needs ring-fenced sustained funding, more research, the right support available across the country and improved universal drug education given earlier in schools and to professionals such as GPs.

In the meantime, Daniel Hrekow is optimistic that if he receives the right kind of help, he will be able to build a life for himself. But his mother, Mary, is angry.

'Everyone on the ground will tell you there's a big problem with young people and cannabis,' she said. 'But where do they or their families go for help? Mental health services are at the bottom of the spending list, and cannabis is even lower.' Mary knows it will be a long and hard road, but she wants her son back.

Why I hate my drug-taking brother

A remarkable first-person account, written for a school essay project, by the 13-year-old sister of an 18-year-old cannabis smoker who suffered from psychosis.

My squitsaphrenic [teacher corrects to schizophrenic] brother: Of course I have to love him because he is a member of my family. However this does not excuse the hatred that goes through my mind every evening that I am forced to share with him. Peter, my brother of 18, is currently ill with squitsaphrenia due to taking drugs (cannabis) from an early age.

He is greedy, lazy, selfish and unbearable. As well as treating myself and my family unfairly, he has no control over his anger, also becomes obsessed with the slightest things, for example: switching the computer off every time it is not in use; pacing around the house; and making pots of tea.

I am genuinely scared of him as well as furious that I have ended up with such a meaningless brother. As a result of this, I try to avoid making eye contact, speaking and even listening to him, as I would bear an even huger grudge against him.

If I were to face him or stand up to him, I would most likely get emotionally hurt or an even huger chance of getting physically hurt because he has no respect for my feelings at all.

The world would not change if he were not here, as it is only my family who knows the true Peter. If I were to re-live the past two years, from when I started to detest him, I would be a carefree teenager.

Bans and busts

·Cannabis was banned in 1928 after a Chinese musician was accused of giving hashish to three women found near-naked in his flat in Cardiff.

·A government committee looking into drug laws, headed by Baroness Wootton, concluded in 1968 that 'the long-term consumption of cannabis in moderation has no harmful effects'.

·Writer Sue Arnold championed cannabis. But in 2003, she told how seeing her son almost destroyed by the drug forced her to change her mind. 'I was so wrong on pot,' she said.